anaemia tutorial

Question 1

Haemolysis definition vs haemolytic anaemia

Answer 1

haemolysis=increased destruction of red blood cells
(reduced red cell survival)

haemolytic anaemia=increased destruction, decrease Hb->
shortened RBC survival->
anaemia

Question 2

how to treat haemolytic anaemia

Answer 2

Folic acid (because of the increased requirement for
erythropoiesis)

• Splenectomy (if severe) to increase red cell life span

Question 3

difference between conjugated and unconjugated bilirubin
-soluble? excreted in urine? what hepatic jaundice? causes?

Answer 3

conjugated
-water soluble
-can be excreted in urine (dark urine)
-accumulates in post-hepatic jaundice
-causes include cholecystitis

unconjugated
-insoluble in blood
-cannot be excreted in urine
-accumulates in pre-hepatic jaundice
-causes include haemolysis

Question 4

what is a direct antiglobulin test

Answer 4

-test to detect presence of ab bound to RBC surface.
-ie. with rabbit ab to human immunoglobulin

-pts with autoantibodies: ab bind to antigen on erythrocyte membrane

Question 5

what does it suggest if DAT is positive (direct antiglobulin test)- and what is it

Answer 5

anti-immune haemolytic anaemia (AIHA)

WHAT:
-associated with SLE/underlying lymphoid cancer (lymphoma)

Question 6

examples of environmental factors which can damage RBC- non-immune vs immune mediated (DAT +ve)

Answer 6

non-immune
-malaria, snake venom

immune
-auto-immune

Question 7

inherited defects and conditions associated with it- abnormal red cell membrane

Answer 7

hereditary spherocytosis

Question 8

inherited defects and conditions associated with it- abnormal Hb

Answer 8

sick cell anaemia

Question 9

inherited defects and conditions associated with it- defect in glycolytic pathway

Answer 9

pyruvate kinase deficiency

Question 10

inherited defects and conditions associated with it- defect in enzyme of pentose shunt

Answer 10

G6PD deficiency- > dysregulation of glutathione metabolism means Red cells are more vulnerable to oxidant damage

Question 11

what does it mean if you can see irregular contracted cells and heinz bodies

and what to avoid if you have this condition

Answer 11

oxidant damage to RBC

-AVOID axidant drugs - don’t eat broad beas

Question 12

difference between intravascular haemolysis and extravascular haemolysis

Answer 12

• Intravascular haemolysis=acute
  damage to the red cell
• Extravascular haemolysis= when defective red
  cells are removed by the spleen

Question 13

treatment of iron deficiency anaemia

Answer 13

iron replacement therapy
ie. Ferrous sulphate tablets

Question 14

List symptoms and signs of iron deficiency anaemia

Answer 14

Diet – vegetarian/vegan

Gastrointestinal symptoms: dysphagia/abdominal pain, haematemesis/rectal bleeding

Menstrual history/post-menopausal bleeding

Weight loss

Medication – e.g. aspirin/NSAIDs

Question 15

clinical signs of iron deficiency anaemia

Answer 15

-koilonychia-centre of nail depressed.
-glossitis
-angular stomatitis- skin irritation on corner of mouth

Question 16

what is hepcidin and when is it secreted

Answer 16

-secreted by liver in response to high iron stores

-hepcidin increased in inflammatory states—> reducing iron supply

Question 17

what is anaemia of chronic disease

Answer 17

Anaemia in patients who are unwell

• bleeding? NO
• reduced red cell survival (haemolysis)? NO
• marrow infiltrated? NO
• iron/B12/ folate deficient? NO

Question 18

common causes of anaemia of chronic disease and treatment

Answer 18

• Infections such as TB and HIV
• Rheumatoid arthritis and other autoimmune disorders
• Malignancy

treat underlying cause

Question 19

difference between vit B12 and folic acid- what they are required for

Answer 19

Vitamin B12 is required for
1. DNA synthesis
2. Integrity of the nervous system

Folic acid is required for
1. DNA Synthesis
2. Homocysteine metabolism

Question 20

causes of vitB12 deficiency and treatment

Answer 20

1) Inadequate diet,
veganism// Oral supplements

2) Gastrectomy or Autoimmune: Pernicious
anaemia (anti GPC
and IF antibodies) //
treat: Hydroxocobalamin
injections (IM)

3) Terminal ileum
* Crohn’s disease or Ileal resection
treat: Hydroxocobalamin
injections (IM)

Question 21

folic acid cause of reduced availability and treatment

Answer 21

diet- poverty/alcohol

malabsorption - disease/resection

treat: oral supplement

Question 22

folic acid and what increases demand– plus treatment

Answer 22

pregnancy
lactation

increase cell turnover - haemolysis

oral supplement

Question 23

microcyte, normocyte, macrocyte- which one is hypochromic, which normochromic

Answer 23

Microcytic – usually also hypochromic

Normocytic – usually also normochromic

Macrocytic – usually also normochromic

Question 24

Inherited defect leading to reduced synthesis of
globin:

Answer 24

THALASSAEMIA

Question 25

what is thalassaemia a vs thalassaemia b

Answer 25

a-defect in a chain synthesis

b-defect in b chain synthesis

Question 26

difference between anaemia of chronic disease and iron deficiency anaemia

Answer 26

anaemia of chronic disease- Ferritin high

iron deficiency anaemia- ferritin low

Question 27

normocytic anaemia causes

Answer 27

-recent blood loss
-failure of production of red cells
-pooling of red cells in spleen (hypersplenism/liver cirrhosis)